Let’s face it: no one really wants to talk about hemorrhoids. But did you know it’s one of the most common gastrointestinal issues in the country? About 1 in 20 Americans has them.
I know hemorrhoids are embarrassing to talk about, but as a gastroenterologist I’ve helped many people find relief from this uncomfortable condition. Simple lifestyle changes (including stopping one very common habit) can help you treat or reduce the risk of getting hemorrhoids.
Here are answers to common questions that many patients have about hemorrhoids.
What are hemorrhoids?
Hemorrhoids, also sometimes called “piles,” are inflamed or swollen veins in the rectum or anus. They can be painful or itchy and may bleed.
Hemorrhoids can be external or internal. External hemorrhoids form under the skin around the anus and can easily be felt with your fingers. Internal hemorrhoids form in the lining of the anus or lower rectum, and you can’t feel them unless they form outside the anal opening.
Hemorrhoids generally don't cause serious health problems, but they can be uncomfortable. Certain behaviors and habits could make you more likely to get hemorrhoids.
How do hemorrhoids form?
We don’t always know what causes hemorrhoids. But they usually develop when too much pressure is placed on the veins around the rectum or anus. When someone has constipation or diarrhea, it can cause straining that leads to this pressure to develop. This can also happen if their bowel isn’t functioning properly from using laxatives or enemas too often.
What common habit can lead to hemorrhoids?
Many of my patients are surprised to learn that sitting on the toilet for long periods can also lead to hemorrhoids. The shape of the toilet seat puts extra pressure on the rectum and anus. This can cause the veins to become swollen when you sit there for a long time. Then when you’re pushing hard during a bowel movement, you've got the potential for hemorrhoids.
Some people need more time to move their bowels than others. But when I ask my patients about their bathroom habits, I often hear about one that is contributing to their hemorrhoids: smartphone usage. Yes, many of us are spending too much time scrolling the web while sitting on the toilet.
What other risk factors can cause hemorrhoids?
Older adults are more prone to hemorrhoids because their supporting rectal tissues are weaker. People who are pregnant, especially those in their third trimester, may also experience hemorrhoids due to a combination of constipation and increased rectal pressure from a growing fetus.
How can I tell if I have hemorrhoids?
Hemorrhoids are hard to miss, so if you think that you might have one, there's a good chance that you're right. Some of the common signs and symptoms include:
- Pain around the anal area, especially when sitting or straining. Rubbing or cleaning the area could also cause more pain.
- Itching around the anal area.
- A feeling of skin protruding during bowel movements.
- Bleeding during bowel movements, which you might notice as blood in your stool, in the toilet bowl, or on toilet paper after wiping.
- Sensitive lumps around the anal area.
What's the best way to treat hemorrhoids?
Hemorrhoids can be managed right at home within the course of a week. When a patient has a mild hemorrhoid, I typically recommend the following:
- Keep bathroom trips short. Limit toilet use to 1 to 2 minutes at a time as much as you can and avoid straining whenever possible.
- Eat more fiber and drink more water. Get 25 to 30 grams of fiber daily, either from fiber-rich foods (such as whole grains, fruits, vegetables, and beans) or supplements (such as Metamucil or Benefiber). This helps make stools easier to pass, reducing the need to strain.
- Try over-the-counter remedies. I frequently recommend hemorrhoid wipes with Witch Hazel, which help to gently cleanse the area while reducing swelling and pain. Hemorrhoid creams are also helpful, but should only be used in moderation as long-term use has side effects. Taking Tylenol is another option, but if your pain is severe and getting worse, you should seek medical care immediately.
- Apply an ice pack to the hemorrhoid area. Ice for 5 to 10 minutes at a time, but not any longer. Place a towel between the ice pack and your skin.
- Take sitz baths several times a day. Spend 10 to 20 minutes sitting in a sitz bath, a shallow amount of warm water. You can add Epsom salt or baking soda to the water to reduce inflammation, but avoid adding soap or bubble bath.
- Clean up after a bowel movement. Wet the area with a peri bottle, which you can buy at a drugstore. Fill the bottle with warm water and apply to the swollen area.
- Regular physical exercise. Exercise helps to promote gastrointestinal motility and reduce constipation.
- Limit intake of fatty foods and alcohol. These can worsen constipation.
Very painful or severe hemorrhoids may need to be treated with a surgical procedure performed by a physician. Depending on the size and location of the hemorrhoid, a gastroenterologist and colorectal surgeon can help determine the best procedure for you.
Do I need to see the doctor for a hemorrhoid?
Hemorrhoids can be treated at home, but you should let your doctor know if your symptoms haven't improved after a week. In some cases, a hemorrhoid could be infected. Serious conditions — such as Crohn's disease, ulcerative colitis, and colon cancer — can also cause rectal bleeding, so it's important to have the condition examined if it isn't getting better. (Keep in mind that hemorrhoids do not cause colorectal cancer or increase a person's risk for it.)
Can hemorrhoids be prevented?
Hemorrhoids can't always be avoided, but the steps to help prevent hemorrhoids are similar to the ones I recommend for coping with them:
- Sit on the toilet if you have the urge to go, but not longer. Try not to spend more than 10 or 15 minutes having a bowel movement and avoid straining or forcing. If you're having trouble going, it's better to get up and try again later than to simply keep sitting there.
- Limit distractions. It's fine to read or look at your phone while you're sitting on the toilet for a few minutes. Just set a timer so you don't end up staying there for too long. (And clean your phone with an antibacterial wipe afterward.)
- Eat more fiber. If you're regularly having trouble going, adding more high-fiber foods to your diet can help. So can limiting your intake of low-fiber foods like cheese, meat, ice cream, fast food, and highly processed snacks.
- Avoid heavy lifting when possible. Straining to lift can put excess pressure on the rectal and anal veins.
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